<p>Nomogram Predicting Overall Survival of Resected Locally Advanced Rectal Cancer Patients with Neoadjuvant Chemoradiotherapy</p>

Abstract

Purpose: The overall survival (OS) of resected locally advanced rectal cancer patients who underwent neoadjuvant chemoradiotherapy (nCRT) was significantly different, even among patients with the same tumor stage. The nomogram was designed to predict OS of rectal cancer with nCRT and divide the patients into different risk groups. Materials and Methods: Based on materials from 911 rectal cancer patients with nCRT, the multivariable Cox regression model was carried out to select the significant prognostic factors for overall survival. And then, the nomogram was formulated using these independent prognostic factors. The discrimination of the nomogram was assessed by concordance index (C-index), calibration curves and time-dependent area under curve (AUC). The patients respective risk scores were calculated through the nomogram. The best cutoff risk score was calculated to stratify the patients. The survival curves of the two different risk cohorts were performed, which assessed the predictive ability of the nomogram. Results: Age, cT stage, pretreatment CEA, pretreatment CA19-9, surgery, posttreatment CEA, posttreatment CA19-9, pT stage, pN stage and adjuvant chemotherapy were selected for the construction of the nomogram. And then the nomogram was constructed with independent prognostic factors. The C-index of the nomogram was 0.724, which showed the nomogram provided good discernment. The acceptable agreement between the predictions of nomogram and actual observations was illustrated by calibration plots for 3-, 5-and 10-year OS in the cohort. Time-dependent AUC with 6-fold cross-validation also showed consistent results of the nomogram. Risk group stratification confirmed that the nomogram had great capacity for distinguishing the prognosis. Conclusion: The nomogram was developed and validated to predict overall survival of resected locally advanced rectal cancer patients with nCRT. The proposed nomogram might help clinicians to develop individualized treatment strategies. However, further studies are warranted to optimize the nomogram by finding out other unknown prognostic factors, and more external validation is still required.

Analysis of Prognostic Factors of Rectal Cancer and Construction of a Prognostic Prediction Model Based on Bayesian Network

“…Zhao et al established a nomogram for the prognosis prediction of metastatic rectal cancer by using the patients' data from the U.S. National Cancer Database (17). Song et al studied the prognostic factors of patients with locally advanced rectal cancer receiving neoadjuvant chemoradiotherapy and established a nomogram for prognostic prediction (18). In addition, another study explored the prognostic predictive role of pathologic features in locally advanced rectal cancer using a nomogram (7).…”

Development and external validation of prognostic nomograms for liver disease-free and overall survival in locally advanced rectal cancer with neoadjuvant therapy: a post cohort study based on the FOWARC trial

“…Song et al developed a nomogram for the OS of LARC patients treated with neoadjuvant therapy (C-index =0.724). However, the training cohort was based on retrospective data, the nomogram lacked external verification, and they did not take into account factors such as tumor nodules and neural invasion (5). In this study, the C-index of the nomogram for the OS of LARC patients was 0.73, and that of the validation cohort reached 0.774.…”

“…Age, serum tumor marker level, pathological TN stage, circumferential resection margin (CRM) involvement, lymph node metastasis, gene mutation and so on were considered to be related factors for the prognosis of LARC. Some scholars have developed nomograms for the prognosis of LARC receiving neoadjuvant therapy, but they were based on the data of retrospective cohort, and did not predict the occurrence of liver metastasis (5)(6)(7). Therefore, on the basis of prospective cohort, the establishment of nomograms that can predict the prognosis of LARC, especially the risk of liver metastasis, is of great significance for identifying potential high-risk patients and adjusting treatment, monitoring and follow-up.…”

A New Nomogram for Predicting the Postoperative Overall Survival in Patients with Middle-Aged and Elderly Rectal Cancer: A Single Center Retrospective Study in Chinese Population

“…In contrast to the other similar studies, this study is first to include the clinical variables of smoking history and family history as independent risk factors in the survival prediction model. 18 , 20 Previous studies have confirmed that smoking significantly affects survival in older people, 21 , 22 and plays a more decisive role in rectal cancer than in colon cancer. 23 Furthermore, the prognosis of colorectal cancer patients who smoke, even if they undergo surgery, is unfortunate, which is consistent with our findings.…”